What is heartburn?

Heartburn is often described as a burning pain just below or behind the breastbone. Some describe the pain as rhythmic or coming in waves from the stomach up toward the chest or the throat. For some people the pain is associated with large or fatty meals, and some experience pain during the night that disturbs their sleep.

It's common for pregnant women to suffer from heartburn. And many people have had the occasional bout of heartburn after a big meal or some spicy food. But for some people, heartburn symptoms happen much more often. Frequent heartburn can be a classic symptom of a condition called gastroesophageal reflux disease (GERD). How do you know if your heartburn is a symptom of GERD? Your doctor will likely diagnose GERD based on a description of the symptoms and their frequency (slight heartburn for 2 or more days a week, or moderate-to-severe symptoms for at least 1 day a week). The frequency or severity of symptoms are NOT good indicators of the degree of esophageal damage. In order to assess esophageal damage, you may need a test called an endoscopy, where a tube is put down to look at the lining of the esophagus. In many cases, though, endoscopy is only done if treatment with medication is not effective, since doctors will often prescribe medications first as a simple diagnostic test for GERD. If the person's symptoms respond to medication, then the doctor concludes that the symptoms were caused by GERD. If not, then further tests, such as endoscopy, are needed.

What causes GERD?

The esophagus is the passageway to carry food from the mouth to the stomach. Because the job of the esophagus is to transport food, the lining of the esophagus is only meant to come in contact with stomach acid (acid and pepsin) for short periods of time. Between the esophagus and the stomach there is a closure so that contents from the stomach will not back up into the esophagus. And if they do, the esophagus is normally able to work the contents back down into the stomach and neutralize the acid.

In people with GERD, the stomach acid remains in the esophagus longer than normal. This happens either because the closure between the stomach and the esophagus is not working well or because the esophagus is not able to work the contents back down and neutralize the acid. Other factors may be the amount of stomach contents or the amount of stomach acid and pepsin.

Saliva is one of the ways the body effectively neutralizes any stomach acid in the esophagus. While we sleep, the amount of saliva decreases. This may contribute to heartburn symptoms at night. Smoking decreases saliva production and nicotine probably affects the closure between the stomach and the esophagus.

Certain foods can make the closure between the esophagus and the stomach not work well - fatty foods, chocolate, and peppermint are some examples. Many prescription medications can also weaken the closure. Obesity is another potential risk factor for GERD.

Can GERD lead to long-term problems?

Long-standing untreated GERD can lead to irritation of the lining of the esophagus (called esophagitis) and scarring of the esophagus. These scars are called strictures and can make swallowing difficult because the esophagus becomes narrower.

Untreated, long-term GERD can cause other problems. Some people with GERD will have cell changes in the lining of the esophagus because of the long-term exposure to stomach acid. This is called Barrett's esophagus and requires regular check-ups, as people with Barrett's esophagus are at increased risk of developing cancer of the esophagus.

When should I see my doctor about heartburn?

If you are bothered by symptoms of heartburn, or if the symptoms are interfering with your sleep or your daily activities, see your doctor. There are medications and non-medication options (lifestyle changes) that your doctor can recommend that may help.

You should also see your doctor as soon as possible if you have:

symptoms starting after 50 years of age

unintended weight loss

anemia or low iron in your blood (you may look pale or feel tired and weak)